Provider Demographics
NPI:1801178801
Name:ZUVICH, MYRA MIRANDA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:MIRANDA
Last Name:ZUVICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N WELLS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6001
Mailing Address - Country:US
Mailing Address - Phone:312-642-4008
Mailing Address - Fax:312-642-5617
Practice Address - Street 1:1601 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6001
Practice Address - Country:US
Practice Address - Phone:312-642-4008
Practice Address - Fax:312-642-5617
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288868183500000X
NJ28RI02138300183500000X
NY042040-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist